1467536862 NPI number — RACHELLE BEATRICE DE LA FUENTE MD

Table of content: RACHELLE BEATRICE DE LA FUENTE MD (NPI 1467536862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467536862 NPI number — RACHELLE BEATRICE DE LA FUENTE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LA FUENTE
Provider First Name:
RACHELLE
Provider Middle Name:
BEATRICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467536862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1226 ESTATES LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11360-1140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-428-8920
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82-68, 164TH STREET
Provider Second Line Business Practice Location Address:
QUEENS HOSPITAL CENTER
Provider Business Practice Location Address City Name:
QUEENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-883-3000
Provider Business Practice Location Address Fax Number:
718-883-6124
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  243246 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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